FORM 1023-EZ for MID VALLEY AND COASTAL CHAPTER EMERGENCY NURSES ASSOCIATION

Field Data
EIN 13-4253988
Case Number EO-2018102-000190
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MID VALLEY AND COASTAL CHAPTER EMERGENCY NURSES ASSOCIATION
Organization’s Mailing Address 24576 TERRITORIAL HWY
City MONROE
State OR
ZIP 97456
Accounting period End 12
Primary contact name CYNTHIA ROLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CYNTHIA ROLER
TREASURER
24576 TERRITORIAL HWY
MONROE OR 97456

Officer/Director/Trustee Two

KAYLEE CORRADO
PRESIDENT
3616 WILTSEY ST SE
SALEM OR 97317

Officer/Director/Trustee Three

JEAN BENSON
SECRETARY
32020 HIDDEN VALLEY RD
LEBANON OR 97355

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/03
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E03 - Professional Societies, Associations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CYNTHIA ROLER
Signature Title TREASURER
Signature Date 4/8/18

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